Provider Demographics
NPI:1659941276
Name:HIDDEN PEACES LLC
Entity Type:Organization
Organization Name:HIDDEN PEACES LLC
Other - Org Name:HIDDEN PEACES
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KIERRA
Authorized Official - Middle Name:ALEXIS
Authorized Official - Last Name:WHITMAN
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:304-839-3035
Mailing Address - Street 1:179 E BURR BLVD STE K
Mailing Address - Street 2:
Mailing Address - City:KEARNEYSVILLE
Mailing Address - State:WV
Mailing Address - Zip Code:25430-4964
Mailing Address - Country:US
Mailing Address - Phone:304-268-5330
Mailing Address - Fax:304-512-3388
Practice Address - Street 1:179 E BURR BLVD STE K
Practice Address - Street 2:
Practice Address - City:KEARNEYSVILLE
Practice Address - State:WV
Practice Address - Zip Code:25430-4964
Practice Address - Country:US
Practice Address - Phone:304-238-5330
Practice Address - Fax:304-512-3388
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-26
Last Update Date:2023-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty